Everett Family YMCA 10/24/2016 - Laserfiche WebLink

I AC RI® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 8/31/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Michelle Parker NAME: Leavitt Group Northwest (A/G No.ext); (425)317-3570 la/c,NO):(425)328-1615 PO Box 9068ss:michelle-parker@leavitt.com INSURER(S)AFFORDING COVERAGE NAIC# Tacoma WA 98490 INSURERA:Zurich American Insurance Company f16535 INSURED INSURER B New Hampshire Insurance Company 023841 YMCA of Snohomish County INSURER C: 2720 Rockefeller Ave INSURERD: Scott Washburn INSURER E: Everett WA 98201 INSURERF: COVERAGES CERTIFICATE NUMBER:16-17 Master REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP WLIMITS LTRINSD VD POLICY NUMBER IMM/DD/YYYY) (MM/DD/YYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000 X 506-882492-1 9/1/2016 9/1/2017 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: To You $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED AUTOS AUTOS 506-882492-1 9/1/2016 9/1/2017 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) Underinsured motorist $ 1,000,000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 B EXCESSLMB CLAIMS-MADE 5821041618 9/1/2016 9/1/2017 AGGREGATE $ 10,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE X ER ANY PROPRIETOR/PARTNER/EXECUTIVEN/A A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) 506-882492-1 9/1/2016 9/1/2017 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under WA StopGap OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: City of Everett Community Development Block Grant The City ofEverett, its officers, employees and agents are named as additional insured as per terms and conditions of the policy CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Everett THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2930 Wetmore Ave Ste 6-A ACCORDANCE WITH THE POLICY PROVISIONS. Everett, WA 98201 AUTHORIZED REPRESENTATIVE Sean King/MIPARK ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I NS025 nnl4nt i